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Utilization Management Specialist
3 weeks ago
Keck Medical Center of USC Los Angeles, United StatesThe Utilization Management Specialist coordinates communication with admitting financial counselors, case management, patient financial services, and payers to ensure all inpatient services provided by the hospital are authorized by appropriate payer. The Utilization Management S ...
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Lvn Utilization Manager
6 days ago
Clinica Romero Los Angeles, United States**Position Title**:LVN Utilization Manager · **Department**:Medical · **Position reports to**:Director of Nursing · **Position Summary**: · The LVN Utilization Manager ensures that health care services are administered with quality, cost efficiency, and within compliance. By cont ...
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Utilization Management Deptartment Lead
3 weeks ago
Radnet Management, Inc. Los Angeles, United StatesOverview: · Artificial Intelligence; Advanced Technology; The very best in patient care. With decades of expertise, we are _Leading Radiology Forward_. With dynamic cross-training and advancement opportunities in a team-focused environment, the core of our success is its people w ...
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Assistant Construction Manager, Utilities
2 days ago
Arcadis Los Angeles, United StatesArcadis is the world's leading company delivering sustainable design, engineering, and consultancy solutions for natural and built assets. · We are more than 36,000 people, in over 70 countries, dedicated to improving quality of life. Everyone has an important role to play. With ...
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Pharmacy Utilization Management Rn
1 week ago
Optum Los Angeles, United StatesFor those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start **Caring. Connecting. Growing together.** · If you are located in PST time zone state ...
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Utilization Manager
3 weeks ago
APLA Health Los Angeles, United StatesJob Details · Job Location · Baldwin Hills - Offices - Los Angeles, CA · Salary Range · $80, $106,345.36 Salary/year · Description · POSITION SUMMARY: · This position is responsible for the management of the daily operations of Utilization Management (UM) at APLA Health and ...
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Utility Account Manager
4 days ago
Insight Global Los Angeles, United StatesTitle: Gas & Electric Utility Client Account Manager · Location: Los Angeles, CA or San Diego, CA (Hybrid) · Salary: $150-$200K · Qualifications: · Bachelor of Science, Engineering, or related technical field. · Minimum 8+ years of related experience, including 4-5 years of direc ...
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Case Manager Utilization Rn-per Diem
3 weeks ago
Kaiser Permanente Los Angeles, United States**Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospital ...
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Case Manager Utilization Rn-per Diem Day
2 weeks ago
Kaiser Permanente Los Angeles, United States**Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospital ...
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Case Manager Utilization Rn, 40/hr Day
3 weeks ago
Kaiser Permanente Los Angeles, United States**Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospital ...
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Case Manager Utilization Rn, 24/hr Day
2 weeks ago
Kaiser Permanente Los Angeles, United States**Sign On Bonus for Eligible External Hires** · **Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not m ...
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LVN Utilization Manager
4 days ago
Clinica Romero Los Angeles, United StatesJob Description · Job DescriptionSalary: · Position Title: LVN Utilization Manager · Department: Medical · Position reports to: Director of Nursing · Position Summary: · The LVN Utilization Manager ensures that health care services are administered with quality, cost efficienc ...
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Utilization Management RN
3 weeks ago
WelbeHealth Los Angeles, United StatesJob Description · Job DescriptionAt WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, functioning as both a care provider and care plan to those individuals we serve. · Our Health ...
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Utilization Management Nurse, Senior
5 days ago
Blue Shield of California Los Angeles, United States Full timeYour Role · The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will ...
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Senior Utilization Management Assistant
2 weeks ago
Providence Los Angeles, United States Full timeUnder the supervision of Regional Director of Care Management, the Utilization Management Coordinator is responsible for providing support to the Care Management team who coordinates care. This position works closely as a healthcare team member and performs complex tasks related ...
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Utilization Management Nurse, Senior
2 weeks ago
Blue Shield of California Los Angeles, United States Full timeYour Role · The Commercial Post Service Review team is responsible for clinically reviewing claims that are the result of either a preservice or claim denial. The Commercial Post Service Review RN will report to the Manager, Post Service. In this role you will perform accurate a ...
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Case Manager Utilization Rn, 40/hr Day
1 week ago
Kaiser Permanente Los Angeles, United States**Sign On Bonus for Eligible External Hires** · **Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not m ...
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Case Manager Utilization Rn, 32/hr Day
6 days ago
Kaiser Permanente Los Angeles, United States**Sign On Bonus for Eligible External Hires** · **Job Summary**: · Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not m ...
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Manager, Utilization Management
3 weeks ago
Optum Arcadia, United StatesFor those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start **Caring. Connecting. Growing together.** · Position in this function is responsible ...
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Manager Utilization Management
2 weeks ago
Kaiser Permanente Panorama City, United States**Job Summary**: · Manages the day-to-day operations of the Utilization Management Program in the Service Area or a Medical Center. Ensures cost effective and quality patient care by appropriate utilization of resources. Provides direction to staff which may include Outside Utili ...
Utility Manager - Los Angeles, United States - AltaMed
Description
The LVN Utilization Management Nurse (UM Nurse) will provide routine review of authorization requests from all lines of business using respective national/state, health plan, nationally recognized guidelines.
Responsibilities
Responsible for the daily review and processing of referral authorizations in accordance to turnaround time (TAT) standards set by ICE/Health Plan
Works collaboratively with Hospitalists, hospital partners, and care teams to provide holistic patient care that is focused on high quality in a cost effective
Monitors ongoing services and their cost effectiveness; recommending changes to the plan as needed using clinical evidence-based criteria – Milliman, Interqual, CMS, National Recognized American Academy of Specific Specialty, Health Plan specific criteria.
Maintains up to date knowledge of rules and regulations governing utilization management processes;
Input data into the Medical Management system to ensure timeliness of referral processing.
Verifies member benefits and eligibility upon receipt of the treatment authorization request.
Ensure timely provider and member oral and written notification of referral decisions.
Coordinates with Medical Director or referral specialists for timely referral processing
Facilitates LOA processing by sending request to Provider Contracting for non-contracted providers or facilities, when applicable
Facilitates LOA processing with the Health Plan for non-contracted facilities
May be responsible for daily concurrent review, retro reviews, discharge planning, pre-certification/prior authorization request review and ensures patients meet appropriate level of care based on acceptable evidenced based criteria.
Perform additional duties as assigned.
Measurements of Success:
I. EXCEEDS PERFORMANCE REQUIREMENTS
Meets the established Performance & Productivity Targets for area (s) of accountability.
Managing multiple priorities, demonstrated by ease and productivity to transition between multiple tasks.
Measurement (s):
Met target on 90% of the Department's Performance Metrics as it relates to core job function.
Exceeds targeted productivity standard
Qualifications
Must reside in CA
Current valid License as a Licensed Vocational Nurse in the state of CA.
Minimum of 2 years of managed care experience
Demonstrated ability to work with automated systems, including electronic medical records and MS Office products such as Word, Excel and Outlook.
Knowledge of federal, state and other applicable standards for clinical practice for assigned area(s) of responsibility.
Ability to work collaboratively with diverse individuals and situations, including strong problem solving and conflict resolution skills.
Job Type:
Full-time
Pay:
$ $45.30 per hour
Benefits:
401(k)
403(b)
403(b) matching
Dental insurance
Health insurance
Life insurance
Paid sick time
Paid time off
Vision insurance
Schedule:
8 hour shift
Day shift
Monday to Friday
Work setting:
Outpatient
Experience:
Nursing: 2 years (Required)
Managed care: 2 years (Required)
License/Certification:
LVN (Required)
Ability to Relocate:
Los Angeles, CA 90027:
Relocate before starting work (Required)
Work Location:
In person
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